Myopic macular degeneration: classification and treatment

Abstract

Abstract Purpose There is no accepted method for the control of progressive high axial myopia, the phenotype of Degenerative Myopia. Myopic Macular Degeneration was studied and classified by clinical presentation, structural features and responses to certain natural and therapeutic changes. Methods Two hundred eyes, with 9.0 D to 24.O D of axial myopia, were evaluated in terms of their clinical presentations, axial length and Optical Coherence Tomography images. The changes occurring with vitreous detachment, macular buckling, vitrectomy and the treatment of exudative complications were also evaluated. Results Vision loss progressed with the length of the eye, the shape of the posterior pole and the age of the patient. The macular degeneration was classifiable into: Atrophic, Exudative, Cicatricial and Neural‐disruptive stages. Macular buckling stabilized axial length and corrected some features of macular traction. Vitrectomy and membrane peeling relieved other aspects of macular traction, but gave no restraint to axial myopia progression. Photo‐dynamic‐therapy and intra‐vitreous anti‐VEGF injections controlled exudative macular complications. Conclusion The stages of Myopic Macular Degeneration were: Atrophic, Exudative, Cicatricial and Neural‐disruptive. Progression was related to time, axial length, posterior pole anatomy and vitreous detachment. Macular buckling limited axial myopia progress and modified schisis and other neural‐disruptive features. It remains to be shown that such surgery can prevent myopic macular degeneration and preserve macular function. Additional vitreous surgery may be required for macular holes, detachments and pre‐retinal fibrosis. Exudative changes were found to respond to treatments for the comparable stage of age‐related macular degeneration.